The government uses a variety of criminal statutes to prosecute health care fraud and abuse

Friday, September 26, 2014

The government uses a variety of criminal statutes to prosecute health care fraud and abuse in addition to the more traditional ones such as the Anti-Kickback Statute and the Health Care Fraud Statute. The government does this oftentimes in an effort to increase the defendant’s sentencing exposure.

In a September 25, 2014 press release, the U.S. Attorney’s Office reported that the owner of a home health care agency in Texas was sentenced to five years in prison for his role in a conspiracy to structure the withdrawal of over $1.8 million from the company’s bank in violation of 31 U.S.C. 5324. The defendant and his wife, who was the director of nursing at the agency, withdrew just under $10,000 in cash from the bank account on nearly 300 occasions in order to avoid the bank’s mandatory reporting requirements of cash transactions of more than $10,000. The defendant then used the money to to pay recruiters in exchange for referring Medicare patients to the agency and to doctors for authorizing home health services that were not medically necessary or provided. A defendant convicted of illegal structuring faces a sentence of five years’ incarceration and a fine of $250,000 for each structured transaction, both of which can be doubled if the defendant is involved in a pattern of structuring that exceeded $100,000 over a twelve month period of time.

In a September 24, 2014 press release, the U.S. Attorney’s Office reported that a medical doctor in East Islip, New York plead guilty to the illegal distribution of oxycodone for issuing a prescription to a patient the doctor knew was using illegal narcotics and abusing pain killers, in violation of 21 U.S.C. 841. Under the Federal Sentencing Guidelines, the penalty for distributing actual oxycodone is the equivalent of a defendant distributing 670% more of heroin